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Thanks to advances in the effectiveness and availability of antiretroviral therapy, or ART, the life expectancy of people living with HIV has increased markedly over the past 30 years. When ART is started early and taken as prescribed, it can reduce the risk of serious illness while increasing a person’s chance of living a normal, healthy life.

To achieve these goals, there are four basic facts you should always remember:

1. ART Controls the Virus — It Doesn’t Cure It

ART works by preventing HIV from replicating at specific stages in its life cycle. Because it is blocked from reproducing at one or more of these stages, the virus is eventually brought under control, to a point at which it is considered “undetectable.”

This doesn’t mean that the virus is gone — just that it exists at low-enough levels that it’s undetectable by lab tests. This is what allows your immune system to continue fighting off infections.

If you stop treatment or take ART inconsistently, the virus will reemerge and your risk of getting sick will be elevated. The virus may also become more difficult to treat. Only by adhering to your treatment regimen — taking your drugs every day for the rest of your life — can you reap the optimal benefits of ART.

2. ART Must Be Individualized to Treat Your Virus

HIV is not just one type of virus — it consists of numerous subtypes (called variants), which differ in both their structure and their viral strength. Genetic tests, or genotype tests, help identify the dominant variants in your blood; to suppress this viral population, a combination of drugs will be tailored to your particular variants.

To determine the drug regimen that’s right for you, you and your doctor will consider a variety of additional factors, including any coexisting medical conditions, potential interactions between HIV medications (or between HIV medications and other medications you’re taking), medication side effects, drug-resistance testing results, your work schedule (and other circumstances that could interfere with your regimen), pregnancy status, and the cost of the medications. The aim is to find the simplest, most effective drug regimen with the fewest possible side effects.

There are currently six classes of HIV drug, each categorized by the stage of the virus life cycle it inhibits. Of these, 27 individual drug agents and 12 combination tablets (comprising two or more agents) have been approved for the treatment of HIV.

For persons newly diagnosed with HIV, the U.S. Department of Health and Human Services (HHS) recommends the use of three medications from at least two classes of drug. In some cases, however, ART may be prescribed in the form of an all-in-one tablet that is taken once a day.

3. Everyone With HIV Should Take ART

In the past, ART was prescribed only when a person’s immune system had begun to weaken (as measured by a subset of white blood cells called CD4 T cells). In part, this was because medications of earlier generations were not only more toxic but more likely to lose their effectiveness as the virus became resistant to them.

The timing of ART changed completely with the publication in June 2015 of the Strategic Timing of Antiretroviral Treatment (START) trial in the New England Journal of Medicine. The study, which included 4,685 HIV-positive people from 35 countries, demonstrated that ART given at the time of diagnosis reduced a person’s risk of serious illness or death by 53 percent.

“With the release of START, the argument was no longer about when to start treatment,” says Linda-Gail Bekker, PhD, an infectious-diseases specialist in Cape Town, South Africa, and the president of the International AIDS Society. “It was about avoiding delays that increase the risk of not only HIV-associated illnesses but non-HIV-associated illnesses as well.”

Following the publication of START, the HHS issued updated guidance in November 2015 calling for the initiation of ART for all persons living with HIV, irrespective of age, race, gender, income, or immune status.

4. HIV Can Become Resistant to ART

Even as you’re using ART, HIV will undergo some natural mutations — and doctors caution that this could contribute to drug resistance in the future. But keeping the virus fully suppressed — that is, adhering strictly to your medication regimen — can help reduce this risk.

When you miss doses or stop ART, the drug concentration levels in your blood begin to fall. This gives drug-resistant mutations more opportunities to multiply and become the dominant variants in your body. And if that happens, the drug-resistant mutations will continue to thrive until the medication can no longer suppress them.

“While treatment failure can occur in the natural course of therapy, it is most often associated with poor adherence,” says Dennis Sifris, MD, an HIV specialist based in South Africa who served as a consultant to the Nelson Mandela Children’s Fund. “And the dismaying part is that failure can leave a person resistant to not only one or two drugs but an entire class of drugs.”

In addition, if this type of drug-resistant virus is passed on to others — either through unprotected sex or other high-risk activities — the newly infected individuals are left with fewer treatment options.